Transcription of Affiliated Customs Brokers USA, Inc. PROFORMA INVOICE
1 EXPORTER (NAME AND ADDRESS) Customs Clearance by: REFERENCE #. PROFORMA INVOICE Affiliated Customs Brokers USA, Inc. PAGE. of PAGES. SPECIAL INSTRUCTIONS. BN# : ULTIMATE CONSIGNEE (NAME AND ADDRESS). IRS# : EXPORTED FROM ( COUNTRY/PROVINCE). BUYER, IF OTHER THAN CONSIGNEE. DESTINATION ( COUNTRY/STATE). TERMS OF SALE - DELIVERY - ETC. IRS# : Ex factory At destination Other or SHIPPING DATE INVOICE DATE DATE OF SALE CURRENCY Bill Customs charges to : Shipper Consignee Other or IF. FOREIGN Payable in Funds GOODS IN LOCAL CARRIER. SAME Parties to this transaction are : Related Not Related CONDITION EXPORTING CARRIER. AS. IMPORTED DECLARED VALUE FOR CARRIAGE Country of origin : Canada US returned goods Other GIVE. COUNTRY MERCHANDISE Temperature controlled Hazardous ITEM # CLASS # UN #. OF. ORIGIN MARKS AND NUMBERS, NUMBER AND KINDS OF PACKAGES, DESCRIPTION OF SHIPMENT GROSS WEIGHT AND CUBAGE.
2 PACKAGES PRODUCT # AND DESCRIPTION HS NUMBER NET WEIGHT QUANTITY UNIT PRICE TOTAL. ABOVE PRICES INCLUDE: Duty Brokerage Freight DECLARATION. DECLARATION BY FOREIGN SHIPPER (To be completed only when the goods described above are of origin and their value exceed $ ). I declare that the articles herein specified are to the best of my knowledge and belief, the growth, produce or manufacture of the United States: That they were exported from the United States from the port of on or about 20 that they are returned without having been advanced in value or improved in condition by any process of manufacture or other means. SHIPPER SIGNATURE date signed MODE OF TRANSPORTATION FROM POINT OF EXIT IF GOODS NOT SOLD, STATE REASON FOR EXPORT. Road Rail Ocean Air Other (loan, repair, processing, etc.). EXPORT PERMIT # TOTAL. Freight charges QPROINVE CONTAINERIZED Yes No THIRD PARTY BILLING (FREIGHT).
3 INSURANCE Declared value FREIGHT Prepaid Collect US PORT OF ENTRY. I HEREBY CERTIFY THAT THE INFORMATION GIVEN ABOVE AND ON THE. TERMS OF PAYMENT CONTINUATION SHEET(S), IF ANY, IS TRUE AND COMPLETE IN EVERY RESPECT. OR. GIVE FIRM NAME AND ADDRESS IF DIFFERENT FROM EXPORTER BOX ABOVE. PACKAGING MISC. TRANSPORT. OCEAN OR INTL COMMISION. FREIGHT. DOMICILE FRT CONTAINER. CHARGES. INSURANCE ASSISTS. Shipper Signature Date Status: Owner Agent INVOICE TOTAL. Clear Form Note: Clicking on 'Clear Form' will erase everything typed above.
